How does a Personalized Rehabilitative Model influence the Functional Response of Different Ankle Foot Orthoses in a Cohort of Patients Affected by Neurological Gait Pattern?

Abstract

Background: Orthoses need to support physiotherapy as well as surgical treatment. Related to patient's rehabilitative goals and pathological gait pattern, orthotists have to produce an orthoses that using an adjustable ankle joint system with preloaded disc springs can store the energy brought in by the body weight and produce a tuning effect on patient's gait and sense of balance. The purpose of this study was to establish how a personalized proprioceptive individualized rehabilitative treatment could infl uence the functional response of different AFOs (Ankle Foot Orthoses) in a cohort of patients affected by neurological gait pattern. Methods:Five patients affected by different neurological gait pattern and volunteered to participate to this study were recruited. The comparative spatio-temporal and functional effect on gait pattern of 3 types of AFOs was investigated under 4 study conditions: 1) without AFO or free-walk (FW); 2) wearing a Codivilla spring, 3) wearing a carbon unjointed AFO ("Toe-Off"); 4) wearing an innovative carbon-kevlar dynamic joint DAFO (DAFONS=Dynamic Ankle Foot Orthoses with Neuroswing). In line with our rehabilitative model, patients underwent to a weekly treatment session, 80 minutes duration per session, for 4 weeks. Evaluation was made before (time T3=time of recruitment) and after our individualized rehabilitative treatment course (time T4=1 month from T3) by using: a. G-Walk sensor (by BTS) spatio-temporal measures in different gait performances; b. clinical/functional outcome measures (Modifi ed Ashworth Scale or MAS for the affected upper and lower limb; Medical Research Council or MRC; orthostatic stability evaluation by using the Berg Balance Scale or BBS).Findings: A comparative analysis of clinical and instrumental data, performed in the pre-defi ned four investigational conditions, showed:√ a statistical insignifi cant change of MRC and MAS scales at time T4, with a signifi cance trend outcome observed at the same time by using the Wilcoxon Signed Rank Test √ a statistical signifi cant difference between test duration (sec) by using Toe-Off vs DAFONS and by using Codivilla spring vs Toe-Off √ a statistical signifi cant increase of the stride length on the left side (% cycle length) by using DAFONS compared to Toe-Off for patient P1, P3 and P5 with a parameter decrease by using DAFONS compared to Codivilla spring and Toe-Off use for patient P2 √ a statistical signifi cant correlation between BBS trend and test duration (sec) by using Codivilla spring at time T3 and T4 √ a statistical signifi cant correlation between the BBS trend and the double gait support duration on the right side (% cycle) with number of left step cycles by using DAFONS at time T3 and T4 √ in a comparative post-treatment visual gait analysis a modifi cation of each patient's static and dynamic postural assessment by using 3 different types of orthoses Interpretation:In line with our study design we noted at the end of the proposed rehabilitative treatment an amelioration of gait quality with th...